Episode 36: Shadowing an Oncology Physician Assistant, Part 2

[00:00:00] Kristen Wynn: I almost feel like I’m here on behalf of all the high school students that want to do this. You know what I mean? Like that we reject and say you’re too young, you’re not allowed in the clinic, whatever. Yeah. So I’m trying to like really listen in and go like, all right, if I wanted to go to med school, what would I be picking up from this?

[00:00:21] Laura Pavitt: Welcome back to Cancer Uncovered. My name is Laura Pavitt and I’m honored to be able to share this very special episode with you. Our very own Kristen Wynn, Program Manager at the Livestrong Cancer Institute’s Dell Medical School, had the opportunity to shadow Lindsay Koziks, the Physician Assistant here in the Oncology Clinic at UTHealth Austin’s Livestrong Cancer Institute.

If you didn’t have a chance to listen to part one of this episode series, As well as the preview to this episode, you won’t want to miss them. In part one, we spoke with Lindsay to break down what it really means to be a physician assistant, also known as a PA, and to hear more about her specialty in hematology, oncology, or blood cancers.

In the preview to this episode, Lindsay describes the art of medicine. Make sure you go back and listen to that clip, because the patient visit you’re about to hear is a perfect example of this creativity in action. Try to keep that sentiment in the back of your mind as you listen in on a typical day, working as a physician assistant, in a busy, growing oncology clinic.

To me, it seems like there’s this rhythm happening, or this dance, if you will, in which Lindsay will first review a patient’s chart in their labs before the appointment. Then she will see them with all of that information in mind. Then after the appointment, she’ll complete any wrap up tasks, such as sending orders or messages before moving on to the next patient of the day.

Let’s see if you can notice that pattern too.

[00:02:03] Lindsay Kozicz: I’m just going to do a quick view of my inbox, um, which includes messages that patients may have sent orders that need to be refilled or filled for patients and then labs. And usually I just look for anything that needs to be like addressed quickly.

So the computer portal is kind of cool. It allows us to communicate with patients asynchronously, um, which is nice for them because they can get communications messages, their labs and stuff that way without having to like. take a phone call, leave a voice message. Um, so that works out really nicely to be able to communicate that way.

And usually, um, multiple times throughout the day, I’m checking the portal to communicate with, with patients kind of real time. Cool. That’s awesome. I feel like portals have been a game changer. For sure. And I have like a, I have a really, um, mixed, Patient panel, which is kind of fun. Um, some people that are recently diagnosed, just going through treatment kind of early on, um, or getting labs for somebody that was treated several years ago, who’s just in surveillance and is doing great.

He’s 33. He has three kids. He’s married, working full time, um, feeling great. Um, so it’s, it’s keeps it interesting, like the variety of, you know, you don’t, you, you never know what you’re necessarily going to see that day.

[00:03:27] Laura Pavitt: Yeah.

[00:03:28] Lindsay Kozicz: But it’s fun. That’s cool.

[00:03:31] Laura Pavitt: I want to jump in and explain a couple of things before we continue.

Lindsay is about to mention the infusion center. This is a broad term for a medical facility that administers medication for patients through an IV. It’s an outpatient facility, meaning that patients will come in to receive the medicine and then go home. They will not stay overnight. In an oncology clinic, the infusion center is often the area that is administering chemotherapy.

It’s meant to be a calming environment with comfy chairs, TV or music, and staff specifically trained to work in this setting. The other thing that Lindsay mentions is a bone marrow transplant. This is a procedure in which unhealthy bone marrow is replaced with healthy, solid bone marrow. Stem cells, it’s a common treatment for certain types of cancers, including those in the blood or the lymphatic system because our bone marrow is responsible for producing blood cells.

Therefore, healthy bone marrow leads to healthy blood. Alright, let’s get back to our day.

[00:04:38] Lindsay Kozicz: Oh, that’s interesting. So we have an uh, patient in the infusion center today that’s starting her treatment for the first day. And so maybe like depending on how the day goes, we may pop over just to. To see her and make sure she’s doing okay.

Some of the patients that we see go to get bone marrow transplant, which we talked a little bit about before. Um, and they leave us, they leave our little nest and they go either to St. David’s locally or to MD Anderson, get their transplant. And then once they are stable enough from the transplant perspective, then they come back.

And so we have somebody that’s coming back from their transplant. So just like the diversity of. patients and kind of where they are in their treatment is always really interesting.

[00:05:24] Laura Pavitt: During the morning, Lindsay had several patient appointments through telehealth or Zoom. However, these patients were not totally comfortable being on a podcast, which is understandable, so of course we did not include those recordings.

Next, you’ll hear Lindsay’s thoughts about the benefits of telehealth as well as the challenges of technology. She will also complete wrap up tasks for these telehealth appointments and then prepare for her next in person appointment.

[00:05:53] Lindsay Kozicz: The cool thing is about being able to do a telehealth visit, which is very different than doing an in person obviously, um, is that Like while I’m talking to them, I can document, I can look stuff up, I can quickly like, like you just saw me looking up like medication he’s on and like reminding myself of something or looking at his med list versus it’s a little more challenging to do that when someone’s sitting in front of you because it’s very obvious that your attention is being directed elsewhere.

Not to say that’s a bad thing, but it’s just like, I think when it’s on telehealth, it’s easier to be able to get away with that.

[00:06:26] Kristen Wynn: Yeah.

[00:06:28] Lindsay Kozicz: Okay. Let’s see the antifusion center is texting. I would say one of the biggest challenges for me from like a balanced perspective is keeping up with all of the ways that people get in touch with us.

So it’s my phone. So it’s tiger text for the infusion center, zoom and teams for the clinic, text and phone for the physicians, the Athena box email for everybody else. So it’s just. It’s just, it’s so much to try to like juggle all of those ways that people can correspond with you. Um, and to not feel like you’re a total like zombie to your phone.

All right. So ordering his labs for next time and then script, do, do, do. Okay. So scheduled with money for one 25 and then we’ll sign. And that gets electronically just sent right over to them. And we’ll send that to Sergio, who’s the nurse that supports our clinic. And we’ll check our messages, see if there’s anything new.

So this next person that we’re going to see is a 71 year old with multiple myeloma. If I’m going to see them in person, I always just try to really quickly look through their labs before I go in, so I remind myself of, like, what exactly. is going on. So, um, he recently trained, changed treatments has been responding really well and not having a whole lot of side effects, which is great.

So just reviewing his labs, labs specific to his disease and then labs just kind of overall blood counts, liver function, kidney function, all that stuff. And everything looks really good. So now we have a few minutes. It’s because our next patient’s in person, so I was just going to walk over to the infusion center.

Okay. I want your warded welcome to come.

[00:08:39] Laura Pavitt: Now we’re really getting into the main part of this episode, in which you’ll hear a raw, real in person appointment between Lindsay and a patient with multiple myeloma. Multiple myeloma is a cancer that affects plasma cells, which are a type of white blood cell. These cancerous plasma cells build up in the bone marrow and end up crowding out healthy blood cells, causing many different symptoms, some of which you’ll hear about.

While you’re listening to this patient visit, try to keep in mind what Lindsay said about the art of medicine. Each patient is so unique with so many different unique factors in their lives. That each patient requires a completely individualized treatment. I think Lindsay does this really beautifully with this patient, and I have a feeling you’ll think so too.

[00:09:31] Lindsay Kozicz: All right. Let’s see if Casey’s up for being recorded. Okay. Okay. Hooray! Yeah, you’re good.

[00:09:41] Kristen Wynn: So they’re going to also record the session. Oh, yay! Okay, good. This is Kristen. Hi! How’s it going? This is her husband. Hi, nice to meet you

[00:09:52] Lindsay Kozicz: both. And Sergio is still doing his thing.

[00:09:55] Kristen Wynn: No worries. Yeah. Thank you so much for being willing to do this.

Yeah. It’s kind of a unique opportunity.

[00:10:03] Casey: Yeah, it was funny when Lindsay asked us if y’all could record. I was like, well, we’re actually asking if we could record this time too, so.

[00:10:09] Kristen Wynn: Everybody’s

[00:10:10] Casey: recording today. It’s just easier for the parents to get a full perspective of what we actually talked about rather than our version of, you know.

[00:10:18] Lindsay Kozicz: Totally. Now

[00:10:19] Casey: I think that’s

[00:10:19] Lindsay Kozicz: so wise. Were we able to get a blood pressure? No, I

[00:10:24] Laura Pavitt: was going like 250. I just stopped it. Um, I can get it at the end of the

[00:10:28] Lindsay Kozicz: That sounds good. There is an um, there is a manual cuff that’s out there. I don’t know if it’s a regular large cuff, but um, we might be able to try that too.

[00:10:37] Casey: Yeah, I can go in at the end. Yeah, that’s fine.

[00:10:40] Lindsay Kozicz: All right. Sounds good.

[00:10:42] Casey: I have lots of questions this time.

[00:10:44] Lindsay Kozicz: Okay, good. That’s great. So you’re calling up on You, you, you passed through, actually, two years, uh, post transplant. That’s amazing. Congratulations. Thank you. God bless you. So tell me how things are going.

I haven’t seen you in a little bit and just give me the, for an update.

[00:11:03] Casey: Um, it seems like everything’s good except for my back. Okay. My back really hurts towards the, whenever I first wake up and whenever I

[00:11:13] Lindsay Kozicz: go to bed. Okay. So kind of like the ends of the day. Yeah. Um, tell me more about that. So it hurts.

It’s

[00:11:22] Casey: like, right here. So more of the lower back. Yeah. Below where your surgery was. Right. Okay. And then, every now and then, it’ll hurt in my shoulder blades. Okay.

[00:11:37] Lindsay Kozicz: And, tell me more about like, what does it feel like? How frequently is it? So,

[00:11:41] Casey: it’s like a, almost every night, whenever I go

[00:11:44] Lindsay Kozicz: lay down.

[00:11:45] Casey: Okay.

[00:11:46] Lindsay Kozicz: So you won’t have the pain, but then you lay down and you get the pain when you lay down.

[00:11:50] Casey: Okay. It’s like towards the end of the day, I know, like when, after we’re eating dinner, it’s like, I know it’s getting close to going to, it’s getting close to bedtime because my pain like starts throbbing.

[00:12:04] Lindsay Kozicz: Okay.

[00:12:04] Casey: My back.

[00:12:05] Lindsay Kozicz: And is it right in the middle or both sides or across the whole low back? Um, right in the middle.

Okay. Okay. And it’s feels like a throbbing pain. Okay. It’s not sharp or stabbing. Does it radiate anywhere? Like move anywhere? Okay. Like to your butt cheeks or down your legs at all? No. Okay. Do you have any weakness associated with it? No. Like difficulty walking, anything like that? Okay. All right. Um, and do you feel like that pain has been getting worse?

It has been getting worse. Okay. Has it been getting more frequent? Yes. Okay. And then when you have the pain on a scale of one to ten, how severe is it? It’s about eight. Okay. And are you taking anything for it?

[00:12:45] Casey: Other

[00:12:46] Lindsay Kozicz: than my gabapentin

[00:12:47] Casey: and You took ibuprofen one time? I took ibuprofen like last night, but that was just for a headache.

You did have leg weakness that one time? But not

[00:12:59] Lindsay Kozicz: consistently?

[00:13:00] Casey: No. Okay. Um, have you

[00:13:02] Lindsay Kozicz: taken the tramadol?

[00:13:04] Casey: I don’t have any. Okay. I went to the pharmacy whenever I contacted you about it and then they never had it.

[00:13:11] Lindsay Kozicz: I wrote a prescription for you in September. Let me look at it.

[00:13:15] Casey: Yeah, I never got

[00:13:16] Lindsay Kozicz: that. Okay.

Alright, so was that helping you when you did have that? Mmhmm. Okay. And what do you think that the pain is from?

[00:13:25] Casey: I don’t know.

[00:13:26] Lindsay Kozicz: It

[00:13:27] Casey: could be a lot of stretching, a lot of exercise, but I don’t know. I don’t,

[00:13:34] Lindsay Kozicz: I don’t know what it’s from. Okay. Alright. When you take the ibuprofen, do you feel like it helps the pain?

[00:13:41] Casey: Sometimes.

[00:13:42] Lindsay Kozicz: Okay.

[00:13:44] Casey: But I know like with me being all blood thinners, it’s not really recommended for me to take ibuprofen also.

[00:13:51] Lindsay Kozicz: Well, so, yeah, multiple reasons that, um, we don’t want you to rely on the ibuprofen. One of which is, is the multiple myeloma in and of itself. Okay. secretes light chains that can affect the kidneys.

Now you’ve been in remission really for almost two years, really since the transplant. So I’m less concerned about that because you don’t have active light chains in your bloodstream.

[00:14:13] Casey: Right.

[00:14:13] Lindsay Kozicz: So I think the likelihood of your kidneys being damaged from the ibuprofen is probably pretty low, but I think that, um, yes, like so being on the blood thinners that that makes your blood less It’s less sick, right?

It treats the factors in your blood that help your blood clot so that we decrease your risk of forming clots. The ibuprofen works in a different way. So the way that ibuprofen causes bleeding risk is through inactivating the platelets. So by targeting those two areas, the platelets and the coagulation factors that can increase your risk of bleeding.

And so we just want to be cautious about that and not use the ibuprofen so regularly that you’re continuously inhibiting your ability for your platelets to function once in a while, I think is fine. And when I say once in a while, like even a couple of times a week is probably okay. But obviously if you’re having pain every day, that’s not going to cut it, right?

Doing ibuprofen a couple of times a week isn’t going to take care of it. So I think there’s two things here. One of which is getting to the bottom of what’s causing the pain, but then also at the same time treating the pain, right? So that you’re able to sleep. Do you feel like it’s inhibiting your ability to sleep?

Okay. And how, how much would you say?

[00:15:35] Casey: So whenever I go to bed. I go to bed around eight ish, eight 30 I am up and then like I’ll wake up and I’ll go to sleep and then I’ll wake up in the middle of the night and I’ll go be able to go back to sleep till like maybe an hour or two later. Okay.

[00:15:57] Lindsay Kozicz: And how many times is that happening, would you say?

Throughout the course of the night? At

[00:16:02] Casey: least twice.

[00:16:04] Lindsay Kozicz: Okay. And when you were using the tramadol. Was that helping you be able to sleep through the night? Yes. Okay. Do you feel like this level of pain that you’re having now is similar to the level of pain that you were having when you were taking the Tramadol previously?

It, it’s a little worse now. Okay. Alright, would you be willing to try the Tramadol to see if that does the trick? Yes, yeah. Okay. So the MRI that we did in December did show some changes associated with it. However, the changes were mostly in the area where the prior surgery was, which is the middle of the thoracic spine.

So, kind of the nipple level is like the, um, about the fourth thoracic vertebrae. So just below that, kind of more in the upper dead back is really where we’re seeing the changes. Yeah. Where you’re describing your pain to me is in the lower part of your back. And there can be lots of reasons for that.

Some of which you kind of had mentioned and described earlier. So given that your multiple myeloma has been in remission for two years since the transplant, I think that, that It’s hard to blame this on the multiple myeloma.

[00:17:14] Casey: Right.

[00:17:15] Lindsay Kozicz: Because it would be unusual to have no other evidence of myeloma in the bloodstream, but to have evidence of myeloma in the back.

And we did a scan just over a month ago that did not show any evidence of problems in the low back, but more just the area where the prior surgery was, was abnormal. So I think that this may be a combination of things like you’re saying, um, and may be beneficial to start physical therapy and to treat you with tramadol.

And if things are not getting better, we can do another scan. But I would like to see if things would get better just with doing physical therapy. If that’s something that you’re open to.

[00:18:00] Casey: Okay.

[00:18:00] Lindsay Kozicz: What do you think?

[00:18:01] Casey: Yes, ma’am. I can do that. Okay. So the question about one of the notes that was on the previous MRI, I think it was your note actually, it mentioned that it was, I can’t remember the exact language, but it said something along the lines of might be indicative of, um, lactic lesions or something to that effect.

[00:18:19] Lindsay Kozicz: So I haven’t seen her since the MR mri.

[00:18:22] Casey: Okay. So, um, and

[00:18:23] Lindsay Kozicz: yeah, I was prob I was reading you the m

[00:18:25] Casey: the

[00:18:26] Lindsay Kozicz: radiology

[00:18:26] Casey: report. Oh, oh, they said Lindsay next to her. That’s why I thought

[00:18:29] Lindsay Kozicz: So the radiology, I’ll tell you exactly what the radiology report says. So there’s an abnormal signal at T seven

[00:18:36] Casey: mm-Hmm.

[00:18:37] Lindsay Kozicz: at the vertebral body, um, corresponding with a lytic abnormality that was.

Seen on the CT back in February that you had so that says that this is not present on older imaging back from 2020 and presumably represents an area of a myeloma deposit, right? In that area, there’s a little bit of a loss of height of the vertebrae, which is not uncommon. And then there’s some compression deformity at the vertebrae just above that.

And then you have the operation that you had from T3 all the way to T10, right? That encompasses that area. So anytime too, that you’ve had surgery in an area that sometimes makes it challenging to interpret the images. I think if there’s any question. Whether or not this is really myeloma related, we could consider doing a PET scan.

[00:19:28] Casey: But

[00:19:28] Lindsay Kozicz: again, I think that the likelihood of this being myeloma related and new is low. The challenge sometimes is that if we don’t have we don’t scan you like every single year, right? Especially because you’ve been so stable. And so sometimes it’s challenging If we do a PET scan now and we don’t have a PET scan to compare from when you started treatment, it will be a little bit difficult to, to interpret.

Okay. Um, but I think it would be reasonable to do it. Okay. So, what I would advocate for is getting you in physical therapy. Okay. I also think that, you know, when we think about the body, when we think about the spine, right, as being, uh, um, area of the body. That’s what we call like a weight bearing bone, meaning that it’s right in the center of your body, right?

Just like your hips, your, your femurs, the lower part of your spine takes the most brunt of our body, right? Because that’s just kind of naturally with gravity. Right. And so I think that as you know, like weight gain has been a challenge for you. And so I think it would be ideal if we could, Try to get a little bit more active and try to reduce your weight a little bit and that may also help.

But I don’t want to say, you know, I don’t know that for sure. Right, so I don’t want to just go, just blame it on that. I think we need to look at all of the possible things that could be going on and adjust accordingly. I would like to see you today, examine you, do a full neurologic exam, an exam of your back, Okay.

Check in with Dr. Matsui, have a conversation about our visit today, and then make a decision about how we want to move forward with this, whether or not we do the scan.

[00:21:18] Casey: Okay. So, um, we’re not looking at a mass then, is that correct? No.

[00:21:23] Lindsay Kozicz: So, what myeloma, um, the way myeloma generally acts, so, so it, it can cause masses, but that’s kind of less common where there’s a collection of plasma cells, the myeloma cells, that can collect anywhere in the body.

Um, and cause like tumors. That’s less common. I’ve seen it, but it’s less common. Usually, because myeloma is a disease of the bones, we see that the myeloma cells will start to break down the bone and cause what we call lytic lesions. So do you think about it, it’s almost like Swiss cheese of the bone, where there’ll be a little area where the myeloma will have eaten away at the normal density of the bone and so it kind of looks like porous in that area.

Whether or not there’s active myeloma in the lytic lesion is hard to say because once there’s a lytic lesion there, it doesn’t generally go away. Okay. So that’s where the PET scan is helpful because the PET scan tells us how much activity is actually in that lesion. So the question really becomes like, well, what would that change?

So if you did have an area that was showing active myeloma in your spine and was causing you pain, well, what could we do about it? Right? So that really, that’s really the question. If it was one solitary area that was kind of showing up and you had no disease anywhere else. So your light chains were normal.

Okay. your M spike is normal, your bone marrow doesn’t show any myeloma, which is really what we’re seeing as of right now, then they can do focal radiation to that one area and treat that one area kind of like we think about it as like, you know, the, the groundhog, like smashing them. The whack a mole. The whack a mole, exactly, yes.

Um, But if you were to have active myeloma and you had disease in the bones, it wouldn’t make sense to do radiation because you can’t radiate everything. So generally we treat you with something like we did initially, which was the case in the beginning, right? So you had disease in your spine, you had surgery, you also had disease everywhere else and so we treated you systemically with chemotherapy and your transplant, right?

So does that make sense?

[00:23:41] Casey: It does. So, I guess the question is, if it’s not myeloma, because it doesn’t look like it is, then what is it?

[00:23:48] Lindsay Kozicz: Well, it probably was myeloma at the beginning, right? Because we know she had disease in her spine. Not only did she have bony disease, but also she had a soft tissue mass near her spine as well.

Okay. It’s kind of both, uh, that collection of the tumor cells outside the bone, and then also The bone was involved as well.

[00:24:08] Casey: Okay. So the question with that then is if it’s showing now, but it wasn’t showing then, like, I guess what caused the change?

[00:24:15] Lindsay Kozicz: Well, it’s hard to know because not every single imaging study that we’ve ever done is, is going to be.

Exactly the same. So sometimes it’s hard to compare a CT to an MR mri. Okay. Um, or a PET scan to an MRI. So the imaging modalities are, it’s challenging unless you scan with the exact same modality every single time to compare apples to oranges. Okay. Right.

[00:24:40] Casey: I, I guess I just kind set off some alarm bells.

Sure. And you know, part of it’s obviously like the parents want to know these questions, you know? Well, there’s

[00:24:46] Lindsay Kozicz: always a question when they say, well, we didn’t see it when we looked back at this scan. But it is like. But did you look at the five scans prior? Right? So I think given your every person that we treat we Have to take that individual case and we have to look at your scan Not just in the scan in the scan report, but we need to look at that in the context of you So one thing you have to keep in mind is that the radiologist doesn’t know you they don’t know your case All they know is what I tell them.

Casey Roethler is a 31 year old female with myeloma who has back pain That’s what I tell them Please do the scan. Okay. Right. But what do I know is I know that Casey is a 31 year old female who has myeloma, who’s been in remission for two years, who presented initially with, you know, paraspinal mass and bone disease of the thoracic spine, right?

I know all this additional information that they don’t know. So we have to take all of that information together and really come up with a recommendation of what we. think is going on based off of what the radiologist tells us. So if that helps.

[00:25:52] Casey: Yeah, that makes a lot of sense. Thank you for clarifying. I know it’s a lot of digging in the questions, but

[00:25:57] Lindsay Kozicz: no, it’s good.

I think it’s really good to, it’s good to be curious about what’s going on and to really understand it.

[00:26:03] Laura Pavitt: I hope that gave all of you listening a good example of the complexity it is to be an oncology physician assistant. You’re not only treating cancer. This is a human in front of you. Who feels pain and just wants to sleep through the night.

And it’s a family who has to deal with the fragmentation of health care. And try to understand the difference between an MRI and a CT and a PET scan. And who also has the responsibility of updating other family members about every appointment. As Lindsay has made so clear, the best clinicians keep all of these factors in mind.

In addition to providing the best cancer treatment possible. No, that is pretty cool.

[00:26:51] Kristen Wynn: So in terms of How these appointments go, right? You’re kind of, I mean, how often are you, how often are you seeing people, right? Like, yeah, it’s probably good for a little bit.

[00:27:00] Lindsay Kozicz: Like, let’s say for example, someone that’s on active treatment who just started, um, like the woman that I was mentioning earlier, I’ll see her every week for the first few weeks just to make sure she’s doing okay.

And if she does, if she’s doing well, we’ll see her. We might switch those visits to every two weeks, every month, depending. Um, someone that comes back right after transplant, I want to keep a closer eye on them than someone that, you know, has been kind of cruising along forever and ever. Um, and so the frequency of visits is really variable depending on the person.

Sure. So usually what I try to do is I always try to. establish with the, both the person that I’m seeing when I want to see them next to make sure that they agree and then schedule them right then when I have them there. That way it’s like we’ve closed the entire loop of the visit. So everything that we talked about in the visit, I put the orders in, you know, before I end the visit, whether it’s labs or PT referral, whatever, um, send any emails.

I try to really keep like all the, everything that needs to happen during that time of the visit so that. Everything, and then they get rescheduled, and then I see them again. Cool. And then I’m just finishing my charting. I try to finish my charting, like, right after I see them, so that I remember. Yeah, totally.

[00:28:18] Kristen Wynn: I’m really taken by, like, how much there is to know and remember, and Yeah. You know, cause I, I’m super spoiled. Like, I haven’t had complicated medical stuff in my family yet.

[00:28:36] Laura Pavitt: Thank you to Lindsay Koziks for sharing her time and expertise so that our listeners could experience a typical day as an oncology physician assistant.

If you have questions or a few of other topics that we can uncover, please email us at livestrongcancerinstitutes at dellmed.utexas.edu and please make sure institutes is plural. You can find out more about the Livestrong Cancer Institutes at dellmed.utexas.edu and about the Livestrong Cancer Institute’s clinic at uthealthaustin.org. If you enjoyed this episode, please make sure to subscribe. Before I let you go, I’m going to play a short preview of a future episode about the role of legislation in healthcare and how it impacts both clinicians and patients, especially as our healthcare system continues to change and evolve.

[00:29:34] Lindsay Kozicz: Quite frankly, in order to move Forward legislation to support PAs becoming more and more autonomous. We have to have physician support. There’s a lot more physicians than there are PAs. So if we don’t have that support, it’s unlikely that we’re going to be able to really move forward.

And so I think that’s a really important relationship to maintain.

[00:29:59] Kristen Wynn: Yeah, absolutely.